Provider Demographics
NPI:1568023349
Name:BURGESS, ALPHIA RAMONA
Entity Type:Individual
Prefix:MRS
First Name:ALPHIA
Middle Name:RAMONA
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ALPHIA
Other - Middle Name:RAMONA
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLBSW
Mailing Address - Street 1:19620 SHADY LANE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3381
Mailing Address - Country:US
Mailing Address - Phone:313-657-1181
Mailing Address - Fax:
Practice Address - Street 1:TEAM WELLNESS CENTER
Practice Address - Street 2:2925 RUSSELL STREET
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-396-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker